ReviewProtection of patients with diabetes, with or without hypertension: implications of ADVANCE for clinical practiceMancia, Giuseppe; Grassi, GuidoAuthor Information Clinica Medica, Department of Medicine and Prevention, San Gerardo Hospital, University of Milan-Bicocca, Monza, Milan, Italy; and Istituto Auxologico Italiano, Milan, Italy Correspondence to Giuseppe Mancia, Clinica Medica, Ospedale S Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy Tel: +39 039 2333357; fax: +39 039 322274; e-mail: firstname.lastname@example.org Conflicts of interest: G.M. has received lecture fees from Servier. G.G. reports no potential conflicts of interest. Journal of Hypertension: May 2009 - Volume 27 - Issue - p S19-S23 doi: 10.1097/01.hjh.0000354420.23557.e2 Buy Metrics Abstract Difficulties in achieving a reduction in morbidity and mortality in patients with diabetes are a result of the complexity of the disease and its intertwined relationship with hypertension and renal impairment. In the recently published Action in Diabetes and Vascular disease: PreterAx and DiamicroN-MR Controlled Evaluation (ADVANCE) trial, treatment of patients with diabetes with the fixed combination perindopril/indapamide on top of background treatments provided clinically and statistically significant reductions in blood pressure (from 145/81 to 136/73 mmHg), all-cause mortality (−14%), cardiovascular mortality (−18%), major cardiovascular events (−9%), renal events (−21%) and new-onset microalbuminuria (−21%) when compared with placebo. As the ADVANCE trial included both hypertensive and normotensive patients, its results suggest that systematically treating all patients with diabetes with perindopril/indapamide, independently of their baseline blood pressure, may have significant long-term value that can be explained partly by the reversal of end-organ damage to the kidney and the heart. Considering that patients with both hypertension and diabetes are characterized by generalized macro- and microvascular disease, the results of the ADVANCE trial, taken together with results of other perindopril/indapamide hypertension studies, support a broad use of perindopril/indapamide treatment for the long-term improvement of prognosis in hypertensive patients as well as in patients with diabetes. © 2009 Lippincott Williams & Wilkins, Inc.